Gregory Shane Dirickson, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2128687 Issued in TX

Practice address

1105 E Fitzgerald St
Bangs, TX 76823-3232

Phone

(325) 752-7682

NPI assigned

May 1, 2019

Last updated

May 1, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1376108704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 14TH ST",
            "city": "BROWNWOOD",
            "state": "TX",
            "postal_code": "768017911",
            "telephone_number": "325-330-2370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E FITZGERALD ST",
            "city": "BANGS",
            "state": "TX",
            "postal_code": "768233232",
            "telephone_number": "325-752-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRICKSON",
        "first_name": "GREGORY",
        "middle_name": "SHANE",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-01",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2128687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "22987159",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gdirickson8966@my.pmi.edu",
            "affiliation": "N",
            "address_1": "2803 14th St",
            "city": "Brownwood",
            "state": "TX",
            "country_code": "US",
            "postal_code": "768017911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bangs Isd
• Bangs Nursing and Rehab Center LLC
• Bangs Physical Therapy Center
• Bangs School Based Health Clinic
• Billie Byers, PTA
• Fannin County Hospital Authority (Bangs Nursing and Rehabilitation)
• Angeline Fields, LVN
• Kenneth J Fitzgerald, R.PH.
• Mary May Guevarra, OTR/L
• Charles Roland Hall, DO

• Physical Therapy Assistant in Bangs, TX
• Providers in Bangs, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.